Bermedo-Carrasco Silvia, Peña-Sánchez Juan Nicolás, Lepnurm Rein, Szafron Michael, Waldner Cheryl
School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 5E5, Canada.
School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 5E5, Canada.
Cancer Epidemiol. 2015 Apr;39(2):229-36. doi: 10.1016/j.canep.2015.01.011. Epub 2015 Feb 21.
To identify factors associated with whether women in Colombia have had a Pap test, evaluate differences in risk factors between rural and urban residence, and evaluate the contextual effect of the lack of education on having ever had a Pap test.
Data used were from the 2010 Colombian National Demographic and Health Survey; 40,392 women reported whether they have had a Pap test. A multilevel mixed logistic regression model was developed with random intercepts to account for clustering by neighbourhood and municipality. The model evaluated whether having a rural/urban area of residence modified the effect of identified risk factors and if the prevalence of no education at the neighbourhood level acted as a contextual effect.
Most women (87.3%) reported having at least one Pap test. Women from lower socioeconomic quintiles (p=0.002), who were unemployed (p<0.001), and whose final health decisions depended on others (p<0.001) were less likely to have had a Pap test. Women with children were more likely to have had the test (p<0.001), and the effects of education (p=0.03), type of health insurance (p=0.01), age (p<0.001), and region (p<0.001) varied with having a rural/urban area of residence. Women living in rural areas (specifically younger ones, with no health insurance, living in the Atlantic and Amazon-Orinoquía regions, and with no education) were less likely to have had a Pap test when compared to those living in urban areas. Furthermore, women living in a neighbourhood with a higher prevalence of no education were less likely to have ever had a Pap test (p=0.005).
In Colombia, the probability of having had a Pap test is associated with personal attributes, area of residence, and prevalence of no education in the neighbourhood. Efforts to improve access to cervical cancer screening should focus on disadvantaged women with limited education, low socioeconomic status, and no health insurance or subsidised insurance, especially those in rural/isolated areas.
确定与哥伦比亚女性是否进行过巴氏试验相关的因素，评估农村和城市居民在风险因素方面的差异，并评估缺乏教育对是否进行过巴氏试验的背景影响。
使用的数据来自2010年哥伦比亚全国人口与健康调查；40392名女性报告了她们是否进行过巴氏试验。建立了一个多层次混合逻辑回归模型，采用随机截距来考虑按邻里和市进行的聚类。该模型评估居住在农村/城市地区是否改变了已确定风险因素的影响，以及邻里层面未受过教育的患病率是否起到背景影响作用。
大多数女性（87.3%）报告至少进行过一次巴氏试验。社会经济五分位数较低的女性（p = 0.002）、失业女性（p < 0.001）以及最终健康决策取决于他人的女性（p < 0.001）进行巴氏试验的可能性较小。有孩子的女性进行该试验的可能性更大（p < 0.001），教育程度（p = 0.03）、医疗保险类型（p = 0.01）、年龄（p < 0.001）和地区（p < 0.001）的影响因居住在农村/城市地区而有所不同。与居住在城市地区的女性相比，居住在农村地区的女性（特别是年轻女性、没有医疗保险、居住在大西洋和亚马逊 - 奥里诺科亚地区且未受过教育的女性）进行巴氏试验的可能性较小。此外，居住在未受过教育患病率较高邻里的女性进行巴氏试验的可能性较小（p = 0.005）。
在哥伦比亚，进行巴氏试验的可能性与个人属性、居住地区以及邻里未受过教育的患病率相关。改善宫颈癌筛查可及性的努力应聚焦于教育程度有限、社会经济地位低且没有医疗保险或补贴保险的弱势女性，尤其是农村/偏远地区的此类女性。
